Speech to the 10th Annual AFR Health Congress
28th February 2008
In the few short months Kevin Rudd has been Prime Minister, we have seen significant changes to this country. Kyoto was ratified. An apology was made to Indigenous Australians. The complex task of winding back the previous Government’s draconian workplace laws has begun. Attention has finally been given to the Reserve Bank’s repeated warnings on inflation.
Last year, when I delivered a speech to this same conference, I talked about how much I wanted to change the country. I talked of the challenges that lay ahead of us in health – how much depended not only on fixing the mistakes of the Howard Government, but in resetting the path this country was on with regards to health care.
I am honoured to stand here a year later and talk of the solid fundamentals we are already laying down as we go about the task of rebuilding our health system.
As a new Health Minister, I am absolutely determined to improve health outcomes for the community, to improve the way health care is delivered in this country and to make it sustainable for the future.
And I believe we are already on our way to doing that.
I have often spoke of the Rudd Government’s dual track approach to health – investing both in prevention and acute care, in recognition of the fact that you can’t separate the two – however much the previous Government may have wanted to.
But there is another, equally important, dual track in the Rudd Government’s approach to health. We are focused on the long term, on delivering reforms that will last far into the future. But we are also aware of the need to act now, to make as much difference as we can to families around Australia who are in need of health care right now.
In other words, we are determined to deliver a fundamental reshaping of the health system in Australia, in order to build a health system for today and for tomorrow.
Today I’d like to talk to you in terms of these dual, dual tracks. First: the interaction between prevention and acute care. And second: what we’ve already done, what we’re doing right now, and how that fits into a wider framework for health care.
An anachronistic approach to health care
Perhaps the greatest disconnect of recent times has been the willingess by governments to treat preventative care and acute care as two separate aspects of the health system.
It is simply not possible to separate the consequences of failing to invest in primary care from the attention we need to give to acute care.
And yet this was the hallmark of the previous Government’s approach to health care.
The last Government was characterised by a willingness to underinvest in prevention and primary care, causing undue pressure on our hospitals, only to shrug its shoulders whenever hospitals buckled under that pressure, saying it was the States’ problem. There was a clear political disincentive for the federal Government to give prevention the focus it deserved, and unfortunately the Howard Government took the easy way out.
To most people in this room, the idea that you can treat prevention and acute care as two separate bundles is at best an anachronism, at worst an absurdity.
Sadly, the clearest example of that anachronism lies in one of the biggest funding agreements that exists in this country – the fact that the Australian Health Care Agreements are entirely focused on public hospitals.
And yet because of the previous Government’s aversion to reform, this change may come ten years too late – yet it could, if successfully designed and negotiated, represent a major revolution in the way that health care in this country is approached.
The fact is - if we want to build a health system for today and tomorrow, we will need to fundamentally reshape the Australian health landscape.
A sudden shift like that will require political will – and most likely - significant political compromise, from all concerned. Luckily, we are at a unique point in this country’s history, with all governments aligned. That is a fortuitous situation to be in. But is doesn’t make change any easier for all of us to envision and deliver.
It is true that when I look around the table at a Health Ministers meeting and see eight Labor Ministers staring back at me, I know that we are all ultimately driven by trying to achieve better outcomes for our communities. But this won’t make reform will simple.
The sad consequence of the last decade of neglect is that it won’t be. The States are under immense pressure. The Commonwealth’s share of funding for public hospitals has fallen from 45% to 41% over the course of a decade. In 2003, $1 billion was ripped out of public hospitals. The politically driven choice of the Howard Government not to invest in prevention has placed further strain on our hospitals. That Government’s reluctance to engage in reform means we are now faced with the challenge of rebuilding after a decade of wasted opportunities.
This difficult environment, in which hospitals are under strain and the problems are so great that disagreements over where to start will flourish, no doubt make it difficult to imagine the compromises that are needed in the weeks and months ahead.
Nevertheless, I have confidence that the our commitment to build a system that is sustainable for the needs of a modern Australia and the commitment to reform of my State and Territory colleagues will get us there. If we want to build the type of health system that a modern Australia deserves – a health system that works both today and tomorrow – then we need everyone on board.
There are tough negotiations ahead, but I am sure that when the Health Care Agreements are delivered, they will deliver a substantively better deal for working families right across Australia.
And in the long term, many of those improvements will come from the recognition, late but better than never, that prevention and acute care must be approached as two sides of the same coin.
The immediate future
That gives you some sense of our overall direction. Let me now tell you what has been done so far.
We’re not quite 100 days in yet. And we have been incredibly busy. Much of this has been focused on getting the architecture of reform right. In our determination to build a health system for today and tomorrow, we are determined to take a long-term view, and to do that well we must make sure our processes are comprehensive and effective. That is why we have been working on the Health Reform Commission, the Australian Health Care Agreements, and the COAG health working group – but I will come to those a little later.
At the same time, we recognise that there is no point saying to the people who need health care right now, “Just hold on while we fix the commonwealth-state division of responsibilities in heath, we’ll be right back in a year or so.”
That’s why, in rebuilding after the dramatic underfunding of the last decade, we have already made major new commitments in health – including $2.5 billion in election commitments which we will deliver on and which will make a sizeable difference to the health care working families receive.
Significantly, we have moved fast on
waiting periods for elective surgery.
We have already
allocated $150 million of federal funding for an immediate blitz on waiting
lists. This funding – the first of its type to be provided by a Federal
Government - will help 25,000 patients get the surgery they need.
That is Commonwealth money, helping 25,000 people by the end of 2008, to help them resume living the lives they had before illness or injury caught them off guard. That is a practical, immediate intervention in the lives of thousands of Australians.
Next we are working on the second tranche of $150 million in funding for the States to deliver long-term reform to elective surgery, to ensure that waiting lists don’t just go down, but stay down.
We have also launched our program to bring 7,750 nurses back into Australia’s hospitals within five years, including bringing 1000 nurses back into the hospital workforce by the end of this year. Cash bonuses of up to $6,000 will be available to eligible nurses and midwives who return to work.
We are well advanced in consultations with the States and doctors on our new GP Super Clinics in under-serviced rural areas.
They will bring together the services of GPs and allied health professionals providing nutrition, diabetes-related and lifestyle modification advice and promoting better multidisciplinary care. I have been heartened by the interest of our Universities in seeing these as good training opportunities for our next generation workforce in primary care.
We have been working on issues like a better system for organ donation.
We have made Indigenous health is a central priority for us. The historic apology to the stolen generations which was made by the Prime Minister in Parliament on our first sitting day has provided a foundation for us to make a better future for Indigenous Australians, particularly children.
The Rudd Government is determined to put in place the infrastructure and services to close the 17-year life expectancy gap between Indigenous and non-Indigenous people within a generation. And half the infant mortality rates much sooner.
We are honouring the financial commitments made by the previous government to the Northern Territory intervention, and will be continuing the child health checks and follow-up services as promised. But we will do much more as well - we will be providing $260 million to give Indigenous babies a better start in life, no matter what community they are born into.
Our new home visiting program, which many of you have probably read about, will start within months. It will provide structured, sustained home visits by health professionals to mothers during pregnancy and continuing through the child’s early life.
At this moment, the chance of an Indigenous baby dying before they turn one is three times higher than for a non-Indigenous baby.
Proper prenatal, postnatal and intensive support for mothers can play a role in reversing this appalling statistic – reducing smoking and drinking during pregnancy, increasing birthweights and reducing neglect, so that Indigenous babies can grow into happy, healthy Indigenous children.
We have also allocated an additional $50 million for alcohol rehabilitation programs, counselling and other programs for Indigenous communities across Australia – which will be implemented with the States and Territories through COAG.
That is a long list of just some immediate actions that have already been taken within the first 100 days of the Rudd Government – the wheels are in motion.
Before too long, we will announce the delivery of more of our election commitments. These will include $290 million for a new Commonwealth Dental Health Plan, to help up to one million Australians get consultations or treatments – another rejection of the previous Government’s hands-off approach. That will be added to in the form of our Teen Dental Plan, to help teenagers access preventative dental checks.
Plans are underway for our Chief nursing and midwifery officer.
We will also deliver on our promise to take pressure off hospitals by delivering more aged care beds, including 2000 transition care beds.
We will roll out our plan to provide
comprehensive pre- and post-natal depression screening, which we believe will
make a significant difference to mothers and to the early childhood of thousands
of babies.
We are also well on
our way to delivering on the Healthy Kids Checks. This Government knows that if
we are to get our education revolution kickstarted, we must invest in early
childhood health. That is what lies behind our commitment to Healthy Kids Checks
We know that if we can make sure kids are healthy and happy, that they can hear
their teacher and see the blackboard, then they will be ready to learn and
absorb the benefits that education will deliver to them.
At the same time, we know that teaching our kids healthy habits when they are young will give them a firm foundation to stay healthy later on.
I recite these achievements to make clear that while we are squarely focused on the future, we have not lost sight of the fact that action is needed right now – and it will be a rare month when you don’t see another significant health announcement coming from the Rudd Government.
Looking to the future – taking the long view
To prepare for the long term will require a fundamental rethinking about health.
This, ultimately, must be the role of a good Government – to examine the landscape as it exists, and then to go about asking how it can be reshaped, and what role the Government should play in that process.
For me, there is a very clear model here.
When Medicare was introduced, it revolutionised the way health care was seen. Overnight, the ability to access quality health care became a birthright. That is one of Labor’s proudest achievements, and it came about through a fundamental re-imagining of the way that health could be done.
The Rudd Labor Government has already made it clear that we are prepared to fundamentally reshape the health landscape as it exists right now.
As I said earlier, we have taken several important steps in laying down the architecture for the long-term reform that will deliver that change.
The most important of those steps was taken on Monday, when the Prime Minister and I announced the creation of the new National Health and Hospitals Reform Commission.
This body is a sign of our commitment to delivering real, lasting solutions. We have asked a group of ten experts, with wide and varied experience in health care, to come together to develop a long-term plan for Australia’s future.
Among our members are people from primary care, a remote area nurse; academics, a former Victorian Liberal Health Minister; a former Labor Premier; doctors and others with experience of the health bureaucracy.
We have chosen some of the very best people in the field, some of the most eminent thinkers and doers in health, to serve the Australian people in this crucial task.
It is a broad church, with far-reaching connections out to every corner of the health care sector, and they are prepared to devote their time to developing a plan for health that will outlast all of us. They have all signed on to thinking outside the square and outside sectoral interests.
Cabinet has asked the Commission to
provide an interim report on a long-term health reform plan to the Commonwealth
Government by the end of 2008, with a final plan to be delivered by
mid-2009.
The Commission will provide a blueprint for tackling future
challenges in the Australian health system including:
· The rapidly increasing burden of chronic disease;
· The
ageing of the population;
· Rising health costs; and
· Inefficiencies exacerbated by cost shifting and the blame game.
It will look at financing, the public private divide and workforce need.
In other words, this Commission has been charged with the responsibility of providing detailed, independent advice to Government on the most challenging aspects of the health system.
This is a significant commitment by the Rudd Government. That’s why we are spending time gathering the information we need, and putting in place the most rigorous plan possible for our future in health.
The Commission will also play a role in the forthcoming Australian Health Care Agreements, providing advice to Government by the end of April on what they believe should be the key aspects of the framework for those agreements.
These Agreements are the most important task of the next few months, and as I have already said, I am sure they will be the subject of robust discussion. They will be the first significant step in delivering on our commitment to end the separation of acute and preventative care.
Already this year we have made important progress in negotiations with the States and Territories. In my few short months as Health Minister, I have had more meetings with my State and Territory colleagues than my predecessor had in the whole of last year!
That said, I am well aware that the negotiations will be tough. Most of you will be aware of recent reports of various bids by States for extra funding. It is their right to ask for more, and we respect that. We have been quite clear on this. We are prepared to look at providing extra resources – but this is a two-way street We will be demanding reform in return.
We will expect improvements in hospital performance. We will expect stringent reporting on hospital performance, including across states, across public and private sectors, and on a hospital by hospital basis. Most importantly, we will expect reform – and I hope to be hearing a lot more from the States in the near future about the types of reforms they are looking at.
If we want to build the type of health system that a modern Australia deserves – a health system that works both today and tomorrow – then we need to change the way we do health. And for that to work, we need the States on board.
We know that hospitals are under pressure because of the drastic underfunding of recent years, but we have a responsibility to working families to make sure that any additional money we spend is spent wisely and well – and we intend to deliver on that
So far, the signs are good that we have embarked upon a new era of Commonwealth-State co-operation.
This intergovernmental co-operation will be a hallmark of our Government. We recognise the need to work across all jurisdictions to deliver the reforms in both the acute and preventative areas, and with that in mind are working within a number of forums.
At the COAG meeting last December, seven working groups were formed, including a COAG health working group, which I chair. The deputy is Robyn Kruk, director-general of the NSW Department of the Premier and Cabinet.
The Government’s willingness to address fundamental health reform in the context of COAG is a sign of how seriously we take the fact that portfolios are intimately connected to one another. Tackling the challenges in health requires a whole of government approach, and we know that.
As another example, one of my first meetings with the other Health Ministers happened alongside a meeting of Treasurers from around the country. That meeting also agreed to reform the complex and inefficient system of Special Purpose Payments – a move that will have a direct impact on the negotiation of the Health Care Agreements.
In health, this means collapsing the many different SPPs that currently exist. This will have the immediate effect of reducing red tape, and the more important effect of giving clear recognition that we are opposed to the silo mentality of the previous Government, and committed to acting in a way which recommends that the various aspects of the health system are intimately connected to one another.
Conclusion
In conclusion: we believe the system can work. But it needs change. It is our job to rebuild the health system to play the role we need it to in a modern Australia. To make it a health system that works both today and tomorrow.
The reasons are not difficult to see. We need to reform the system because it is not coping with the challenges which have built up in the past decade and which, without reform, will develop into crises in the decades to come.
These long term challenges include the ageing of the population; the growing burden of chronic disease; the escalating cost of new health technologies and pharmaceuticals; and shortages of doctors and other health professionals in many areas, especially outside our major cities.
This Government has the means and determination to drive the reforms that will enable us to meet these challenges head on. We intend to fundamentally reshape the health landscape, because nothing else will deliver the health system that a modern Australia deserves.
We know that there is a lot of work ahead of us. But instead of feeling burdened by it, I, for one, am excited. The opportunity to take part in something so important is an honour. It is why we wanted to win Government and now we have the challenging opportunity ahead of us.